Archived: Ashton Manor

Ashton Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashton Manor is a care home, without nursing and accommodates up to 22 people in one adapted building, for people with mental health conditions, people living with dementia and older people. At the time of inspection, there were 22 people living at the service.

The home is situated in Bognor Regis, West Sussex and accommodation was provided over three floors. There were assisted bathrooms on each floor, a large dining room, leading to the garden and one lounge area on the ground floor.

Ashton Manor is one of four services owned by the provider, who have two other homes and a domiciliary care agency (DCA) in the local area.

At our last inspection on 08 March 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The manager registered with the Care Quality Commission in October 2012. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service continued to have robust safeguarding systems, policies and procedures to protect people from abuse. Local safeguarding procedures were followed to respond to safeguarding concerns promptly.

Risks to people continued to be assessed and people were supported to take positive risks.

People were given their medicines as prescribed. Medicines were ordered, stored and disposed of safely, according to the provider’s policies and procedures.

There were sufficient numbers of staff to support people and meet their needs. The provider completed pre-employment checks for all new members of staff. These checks help the provider to make safer recruitment decisions and help prevent unsuitable staff from working with people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s care, treatment and support continued to be delivered to a high standard and in line with current legislation. People were supported to maintain a balanced diet and had access to healthcare services, when needed.

People continued to be treated with kindness, respect and compassion. We saw people being actively involved in making decisions about their care, as far as possible, such as; choice over food and drinks, participating in activities and personal care.

People continued to receive good person-centred care and were involved in developing their care plans. People felt confident to raise a complaint and speak to the registered manager, if needed.

People received personalised care, that was responsive to their needs, in areas such as engagement with the local community and how people were supported to follow their interests and hobbies.

Ashton Manor continued to promote a positive culture that was person-centred, open, inclusive and empowered people to live healthy, active lives.

The registered manager and provider actively involved staff in opportunities to continuously learn and improve the quality of the service, taking on board feedback from people, relatives and professionals.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe with staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Potential risks to people had been identified and assessed appropriately. There were sufficient numbers of staff to support people and safe recruitment practices were followed. Medicines were managed safely.

Staff had received all essential training and there were opportunities for them to study for additional qualifications. All staff training was up-to-date with refresher courses booked for people. Team meetings were held and staff had regular communication with each other at handover meetings which took place between each shift.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the registered manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. They had access to healthcare professionals. People’s rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were communicated to staff in a variety of ways – verbally, through physical gestures or body language. People were involved in decisions about their care as much as they were able. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided information about people in a person-centred way. People’s preferences and likes and dislikes were documented so that staff knew how people wished to be supported. Some people went out into the community independently while others required staff support. There were a variety of activities and outings on offer which people could choose to do. Complaints were dealt with in line with the provider’s policy.

People could express their views and discuss any issues or concerns with their keyworker, who co-ordinated all aspects of their care. The culture of the service was homely and family-orientated. Regular audits measured the quality of the care and service provided.

The focus of the inspection was to carry out an unannounced inspection of Ashton Manor. We looked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

This inspection was carried out over two visits. Each visit was carried out by an individual inspector.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, and the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw the service was clean and safe. This meant that people were not placed at unnecessary risk. We saw evidence that regular maintenance of the lift and hoist were carried out. The environment was well lit and comfortable for people to relax in. People that we spoke with told us that they were satisfied with the cleanliness of the service and with the environment in which they lived. We saw two cleaners were employed on a daily basis. Staff told us, "If there are any issues after the cleaners have gone we take care of it'.

People's nutritional needs were met and there was a choice of suitable nutritious food and drinks available.

There were enough qualified, skilled and experienced staff to meet people's needs. Staff were supported to deliver care and treatment safely and to an appropriate standard.

The service was able to clearly demonstrate where Deprivation of Liberty Safeguards (DoLS) had been put in to effect. This demonstrated the service understood the principles of and their responsbilities in relation to the Mental Capacity Act 2005 and DoLS

Is the service effective?

We found that care plans were detailed and informative. In addition, residents' meetings had taken place in order to support people to make decisions about their care and services provided. This meant that people were sure that their individual care needs and wishes were known and planned for.

People told us that they were happy with the care and support they received. For example, one person told us, 'I'm happy with the care given and my needs are being met'. Another person told us, 'All the staff are lovely. They help me when I need it'. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We observed people being supported to do things at their own pace. One person told us, 'I like to paint and I am being helped to do a border in the lounge'. Another person told us 'I like the food and choices we have'.

Is the service responsive?

Records confirmed people's preferences and interests had been recorded and care and support had been provided that met their wishes. People had access to in house activities, occasional external events and had been supported to maintain relationships with their friends and relatives.

We observed the service had responded to a poor food hygiene rating dated August 2013. The provider addressed the areas of concern which enabled them to achieve the highest rating at the following inspection.

Is the service well-led?

We observed that care planning was detailed and person centred. The service had a rolling quarterly quality assurance system in place. We observed different outcomes were assessed at each review which ensured all areas of care were being maintained.

Staff told us they were clear about their roles and responsibilities. We observed staff interacting with people in a way that showed they understood the ethos of the home. This ensured people received a good quality service at all times.

We saw in care records that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person told us "Staff explain what needs to be done". Another person told us "I get asked about care and treatment and I could refuse if I wanted to". People told us that they were treated with respect and dignity.

We saw evidence that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw that the Deprivation of Liberty Safeguards (DoLS) team was consulted if there were any queries regarding deprivation of anyone's liberty.

People were protected by the homes medicines procedures.

We saw that there were effective recruitment processes in the home to ensure that people were safe and well looked after.

We saw that staff were appropriately trained and supported to fulfil their role.

There was a complaints procedure in place and people told us that they could complain and that they would be listened to.

There were quality assurance systems in place to monitor the service provided for people.

People spoken with told us that their privacy and dignity were respected and that they had choices in daily living activities.

They told us they felt safe in the home and one person told us that the staff were "wonderful" and that "They do everything they can". Another told us "The food is always good".

We spoke with three staff, including the manager and we were told this was a supportive organisation to work for and that there were training opportunities.

We spoke with a professional from the local mental health team who told us the home was a therapeutic environment and the people's needs were met in a flexible manner.

A member of the district nursing team spoken with told us that the staff were always helpful. We were also told that the staff deal well with people with challenging conditions.

We spoke with one relative on the telephone and we were told that the staff were "brilliant and kind". This relative went on to say "They have been fantastically accommodating".